Private Sector Rides To Rescue Of HealthCare.gov

Handful of Web insurance brokers will start enrolling people in HealthCare.gov plans within a month, but backend coding problems could continue to delay completion of policy purchases.

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The private sector is riding to the rescue of HealthCare.gov, the troubled federally operated health insurance exchange. Five Web insurance brokers that signed a deal last Julywith the Centers for Medicare and Medicaid Services (CMS) are expected to start enrolling subsidy-eligible people in plans that participate in HealthCare.gov within the next month.

That should go a long way toward easing the pressure on the front end of HealthCare.gov, which has encountered significant technical problems in enabling people to sign up for plans. But less-publicized difficulties in sending enrollment data to insurance companies' backend systems could still delay the process for some time to come, a leading expert warns.

At an earnings conferencewith security analysts on Thursday, Gary Lauer, CEO of eHealth, which operates ehealthinsurance.com, one of the leading online insurance agencies, announced, "We continue to work with the federal government to launch enrollment capabilities for subsidy-eligible individuals in the 36 states where the federal government is operating an exchange. eHealth has received the necessary information for implementation of this capability from CMS … But we received this later than expected. We are currently in the process of operating and testing. Assuming the federal exchange is operable, we hope to be able to provide eHealth consumers access to subsidy-eligible plans during this open enrollment period in time for the Jan. 1, 2014 effective date of coverage."

In an interview with InformationWeek Healthcare, Sam Gibbs, president of government systems for eHealth, said that the company anticipates going live with that capability "within the next few weeks. A handful of other Web-based entities will be launching at some point. My guess is in the next month you'll see other companies begin to offer subsidy-eligible plans and do the subsidy calculations through the FFM [Federally Facilitated Marketplace], and we'll be one of those."

Besides the national Web insurance brokers who signed up with CMS last summer, Gibbs believes the agency is enlisting additional regional and statewide agencies to help enroll people in the federally run exchange.

A CMS spokesperson told InformationWeek, "We’re still signing agreements on a rolling basis with these parties and will have a more complete list to share soon."

Since Oct. 6, eHealth has been offering Affordable Care Act-qualified health plans to customers who are ineligible for government subsidies because of their income, Gibbs noted. These plans are being sold independently of the FFM and the state-run exchanges in 14 states. But they meet all of the qualifications for a plan that is offered on one of these exchanges, and the premiums charged to customers for a particular plan are the same whether they're available in an exchange or not.

To enroll people who are eligible for subsidies -- the vast majority of those interested in purchasing exchange plans -- eHealth and the other four brokers must connect to the CMS data hub to verify applicants' incomes and calculate the amount of subsidies they can receive. eHealth is still testing its ability to get that information and to link with other FFM systems. "We didn't get the test environment until Sept. 30," Gibbs explained.

When eHealth is ready to begin enrolling subsidy-eligible individuals in the FFM plans, it will do so on its own. "We'll do our own marketing to our own customer base, and if one of our customers wants a subsidy, we'll take them through our site and help them pick a plan," Gibbs said. "When they're ready to enroll, we'll send them to the federal exchange for enrollment completion, and then the exchange will send that enrollment to the carrier."

Show me one company these days that does effective beta periods? They all point to Google and claim that Google still makes money having every product in beta indefinitely. As long as features win out over quality users will have to get used to mediocre applications.

Ken really hit the nail on the head when he notes the private sector's critical role in government IT programs. This is especially true with healthcare where digitization, document management, and cybersecurity are always important elements in the process. Best commercial practices should be used as a metric more often when designing and implementing enterprise-wide programs in government.

The current issues with healthcare.gov will be fixed, but these issues are the tip of the iceberg; the next gaggle of issues will be far more difficult to fix. Without appointing a proven, competent Program Exec., this will be one major crisis-fix cycle after another.